Q: Dr. Eppley, I am looking for some insight as to what to do with my undereye hollows. I am 50 years old and starting to show a little hollowing under eyes. I think the fat has shifted and there is less volume. I’m looking for ideas as to the best and least invasive way to improve it. I had a lower blepharoplasty about six years ago. I have heard conflicting views on using temporary synthetic fillers (Radiesse, Juvaderm, etc) vs. fat injections. If I did something, I would prefer permanent, rather than a touch up every 6 months or so. Perhaps you could comment on fat injections and whether its a reliable way to correct this. I do have some creepy skin underneath and would like to know about skin resurfacing, laser, etc… No knives and cutting for me.
A: When it comes to under eye hollowing, it is an issue of volume addition. But there is no under eye filler approach that can guarantee smoothness or permanency. Fat is the only injectable option that may achieve some permanency but it has the risk of unevenness or small lumps. While they would likely not be seen, they may be felt. It is just the nature of a filler that does not have linear flow coming out of the end of the injection cannula. If you particulate the fat into a liquid that will have linear flow, then there will likely be 100% absorption of the injectate.
The best approach to undereye skin tightening is fractional laser resurfacing which can be done in the office under topical anesthesia. Because of the very thin skin of the lower eyelid, one has to be careful to be too aggressive to avoid a burn injury. Thus it may require more than one fractional laser treatment to get the best result.
Dr. Barry Eppley